DISORDERS OF LASHES

1. Trichiasis

2. Metaplastic lashes

3. Distichiasis

4. Phthiriasis palpebrarum

6. Poliosis

5. Madarosis

Trichiasis

• Posterior misdirection of normal lashes

• Most frequently affects lower lid

Complications

• Inferior punctate epitheliopathy

• Corneal ulceration and pannus

Signs

Treatment Options for Trichiasis

1. Epilation - but recurrences within few weeks

2. Electrolysis - but frequently repeated treatments required

3. Cryotherapy - for many lashes

4. Laser ablation - for few scattered lashes

5. Surgery - for localized crop resistant to other methods

Metaplastic lashes

Cicatrizing conjunctivitis (ocular pemphigoid, Stevens-Johnson, chemical burns)

Aberrant lashes arising from meibomian gland orifices

Signs Causes

Distichiasis

• Second row of lashes arising from meibomian gland orifices• Congenital • Cryotherapy to posterior lamella

• Division into anterior and posterior lamellae

• Reapposition of lamellae

TreatmentSigns

• Occasionally dominantly inherited

Phthiriasis palpebrarum• Infestation of lashes by pubic crab louse and its ova (nits)• Typically affects children in poor hygenic conditions

Treatment - removal, destruction and delousing Lice gripping base of lashes Nits and empty shells adhere to base of lashes

Madarosis

Local causes• Chronic anterior lid margin disease• Infiltrating tumours• Burns, radiotherapy or cryotherapy

Systemic causes• Generalized alopecia• Myxoedema• SLE• Syphilis• Leprosy

Following removal

Decrease in number or complete loss of lashes

Poliosis Premature localized whitening of hair

Ocular associations

• Chronic anterior blepharitis

• Sympathetic ophthalmitis

• Vogt-Koyanagi-Harada syndrome

• Waardenburg syndrome

Systemic associations